51
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Yang MS, Jee YK. How to Apply the Concept of Cough Hypersensitivity in Clinical Practice? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:589-592. [PMID: 31332971 PMCID: PMC6658411 DOI: 10.4168/aair.2019.11.5.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Min Suk Yang
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
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52
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Won HK, Kang SY, Kang Y, An J, Lee JH, Lee SM, Kwon JW, Kim MH, Jo EJ, Lee SE, Kim SH, Kim SH, Chang YS, Kim SH, Lee BJ, Cho SH, Birring SS, Song WJ. Cough-Related Laryngeal Sensations and Triggers in Adults With Chronic Cough: Symptom Profile and Impact. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:622-631. [PMID: 31332974 PMCID: PMC6658400 DOI: 10.4168/aair.2019.11.5.622] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/04/2022]
Abstract
Purpose Recent evidence suggests that cough hypersensitivity may be a common feature of chronic cough in adults. However, the clinical relevance remains unclear. This study evaluated the cough-related symptom profile and the clinical relevance and impact of cough hypersensitivity in adults with chronic cough. Methods This cross-sectional multi-center study compared cough-related laryngeal sensations and cough triggers in patients with unexplained chronic cough following investigations and in unselected patients newly referred for chronic cough. A structured questionnaire was used to assess abnormal laryngeal sensations and cough triggers. Patients with unexplained cough were also evaluated using the Leicester Cough Questionnaire (LCQ) and a cough visual analogue scale (VAS), and these scores were assessed for correlations with the number of triggers and laryngeal sensations. Results This study recruited 478 patients, including 62 with unexplained chronic cough and 416 with chronic cough. Most participants reported abnormal laryngeal sensations and cough triggers. Laryngeal sensations (4.4 ± 1.5 vs. 3.9 ± 1.9; P = 0.049) and cough triggers (6.9 ± 2.6 vs. 5.0 ± 2.8; P < 0.001) were more frequent in patients with unexplained chronic cough than in those with chronic cough. The number of triggers and laryngeal sensations score significantly correlated with LCQ (r = −0.51, P < 0.001) and cough VAS score (r = 0.53, P < 0.001) in patients with unexplained chronic cough. Conclusions Cough hypersensitivity may be a common feature in adult patients with chronic cough, especially those with unexplained chronic cough. Cough-related health status and cough severity were inversely associated with the number of triggers and laryngeal sensations, suggesting potential relevance of assessing cough hypersensitivity in chronic cough patients.
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Affiliation(s)
- Ha Kyeong Won
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Sung Yoon Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yewon Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Jin An
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hyang Lee
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Min Hye Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Eun Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Seung Eun Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sae Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Heon Kim
- Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea
| | - Yoon Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Hoon Kim
- Department of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Byung Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Woo Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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53
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McGovern AE, Short KR, Kywe Moe AA, Mazzone SB. Translational review: Neuroimmune mechanisms in cough and emerging therapeutic targets. J Allergy Clin Immunol 2018; 142:1392-1402. [DOI: 10.1016/j.jaci.2018.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 12/27/2022]
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54
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Satia I, Badri H, Lahousse L, Usmani OS, Spanevello A. Airways diseases: asthma, COPD and chronic cough highlights from the European Respiratory Society Annual Congress 2018. J Thorac Dis 2018; 10:S2992-S2997. [PMID: 30310687 PMCID: PMC6174133 DOI: 10.21037/jtd.2018.08.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Imran Satia
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Huda Badri
- Division of Infection, Immunity and Respiratory Medicine, and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Lies Lahousse
- Pharmaceutical Care Unit, Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Omar S. Usmani
- National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital, London, UK
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
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55
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Mazzone SB, Chung KF, McGarvey L. The heterogeneity of chronic cough: a case for endotypes of cough hypersensitivity. THE LANCET RESPIRATORY MEDICINE 2018; 6:636-646. [DOI: 10.1016/s2213-2600(18)30150-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/31/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022]
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56
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Slinger C, Mehdi SB, Milan SJ, Dodd S, Blakemore J, Vyas A, Marsden PA. Speech and language therapy for management of chronic cough. Hippokratia 2018. [DOI: 10.1002/14651858.cd013067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Claire Slinger
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Syed B Mehdi
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | | | - Steven Dodd
- Lancaster University; Faculty of Health and Medicine; Lancaster UK
| | - Jessica Blakemore
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Aashish Vyas
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Paul A Marsden
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
- Lancaster University; Faculty of Health and Medicine; Lancaster UK
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57
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Driessen AK, McGovern AE, Narula M, Yang SK, Keller JA, Farrell MJ, Mazzone SB. Central mechanisms of airway sensation and cough hypersensitivity. Pulm Pharmacol Ther 2017; 47:9-15. [DOI: 10.1016/j.pupt.2017.01.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/25/2017] [Indexed: 12/11/2022]
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58
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Bonvini SJ, Belvisi MG. Cough and airway disease: The role of ion channels. Pulm Pharmacol Ther 2017; 47:21-28. [PMID: 28669932 DOI: 10.1016/j.pupt.2017.06.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 01/07/2023]
Abstract
Cough is the most common reason for patients to visit a primary care physician, yet it remains an unmet medical need. It can be idiopathic in nature but can also be a troublesome symptom across chronic lung diseases such as asthma, COPD and idiopathic pulmonary fibrosis (IPF). Chronic cough affects up to 12% of the population and yet there are no safe and effective therapies. The cough reflex is regulated by vagal, sensory afferent nerves which innervate the airway. The Transient Receptor Potential (TRP) family of ion channels are expressed on sensory nerve terminals, and when activated can evoke cough. This review focuses on the role of 4 TRP channels; TRP Vannilloid 1 (TRPV1), TRP Ankyrin 1 (TRPA1), TRP Vannilloid 4 (TRPV4) and TRP Melastatin 8 (TRPM8) and the purinergic P2X3 receptor and their possible role in chronic cough. We conclude that these ion channels, given their expression profile and their role in the activation of sensory afferents and the cough reflex, may represent excellent therapeutic targets for the treatment of respiratory symptoms in chronic lung disease.
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Affiliation(s)
- Sara J Bonvini
- Respiratory Pharmacology Group, Airway Disease Section, National Heart & Lung Institute, Imperial College, Exhibition Road, London SW7 2AZ, UK
| | - Maria G Belvisi
- Respiratory Pharmacology Group, Airway Disease Section, National Heart & Lung Institute, Imperial College, Exhibition Road, London SW7 2AZ, UK.
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59
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Belvisi MG, Birrell MA, Wortley MA, Maher SA, Satia I, Badri H, Holt K, Round P, McGarvey L, Ford J, Smith JA. XEN-D0501, a Novel Transient Receptor Potential Vanilloid 1 Antagonist, Does Not Reduce Cough in Patients with Refractory Cough. Am J Respir Crit Care Med 2017. [DOI: 10.1164/rccm.201704-0769oc] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maria G. Belvisi
- Respiratory Pharmacology Group, Division of Airway Disease, National Heart and Lung Institute, Imperial College London, United Kingdom
- Innovative Medicines and Early Development, IMED RIA, AstraZeneca, Mölndal, Sweden
| | - Mark A. Birrell
- Respiratory Pharmacology Group, Division of Airway Disease, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Michael A. Wortley
- Respiratory Pharmacology Group, Division of Airway Disease, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Sarah A. Maher
- Respiratory Pharmacology Group, Division of Airway Disease, National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Imran Satia
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Huda Badri
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Kimberley Holt
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Patrick Round
- Ario Pharma Ltd., Cambridgeshire, United Kingdom; and
| | - Lorcan McGarvey
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
| | - John Ford
- Ario Pharma Ltd., Cambridgeshire, United Kingdom; and
| | - Jaclyn A. Smith
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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60
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Paz C, Suárez E, Parga O, Vence J. Glottis effects on the cough clearance process simulated with a CFD dynamic mesh and Eulerian wall film model. Comput Methods Biomech Biomed Engin 2017; 20:1326-1338. [PMID: 28782386 DOI: 10.1080/10255842.2017.1360872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this study, we have reproduced the cough clearance process with an Eulerian wall film model. The simulated domain is based on realistic geometry from the literature, which has been improved by adding the glottis and epiglottis. The vocal fold movement has been included due to the dynamic mesh method, considering different abduction and adduction angles and velocities. The proposed methodology captures the deformation of the flexible tissue, considers non-Newtonian properties for the mucus, and enables us to reproduce a single cough or a cough epoch. The cough efficiency (CE) has been used to quantify the overall performance of the cough, considering many different boundary conditions, for the analysis of the glottis effect. It was observed that a viscous shear force is the main mechanism in the cough clearance process, while the glottis closure time and the epiglottis position do not have a significant effect on the CE. The cough assistance devices improve the CE, and the enhancement rate grows logarithmically with the operating pressure. The cough can achieve an effective mucus clearance process, even with a fixed glottis. Nevertheless, the glottis closure substantially improves the CE results.
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Affiliation(s)
- Concepción Paz
- a School of Industrial Engineering , University of Vigo , Vigo , Spain.,b Biofluids Research Group , Galicia Sur Heath Research Institute (IIS Galicia Sur), SERGAS-UVIGO , Vigo , Spain
| | - Eduardo Suárez
- a School of Industrial Engineering , University of Vigo , Vigo , Spain.,b Biofluids Research Group , Galicia Sur Heath Research Institute (IIS Galicia Sur), SERGAS-UVIGO , Vigo , Spain
| | - Oscar Parga
- a School of Industrial Engineering , University of Vigo , Vigo , Spain
| | - Jesús Vence
- a School of Industrial Engineering , University of Vigo , Vigo , Spain
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61
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Mazzone SB, Undem BJ. Vagal Afferent Innervation of the Airways in Health and Disease. Physiol Rev 2017; 96:975-1024. [PMID: 27279650 DOI: 10.1152/physrev.00039.2015] [Citation(s) in RCA: 326] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Vagal sensory neurons constitute the major afferent supply to the airways and lungs. Subsets of afferents are defined by their embryological origin, molecular profile, neurochemistry, functionality, and anatomical organization, and collectively these nerves are essential for the regulation of respiratory physiology and pulmonary defense through local responses and centrally mediated neural pathways. Mechanical and chemical activation of airway afferents depends on a myriad of ionic and receptor-mediated signaling, much of which has yet to be fully explored. Alterations in the sensitivity and neurochemical phenotype of vagal afferent nerves and/or the neural pathways that they innervate occur in a wide variety of pulmonary diseases, and as such, understanding the mechanisms of vagal sensory function and dysfunction may reveal novel therapeutic targets. In this comprehensive review we discuss historical and state-of-the-art concepts in airway sensory neurobiology and explore mechanisms underlying how vagal sensory pathways become dysfunctional in pathological conditions.
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Affiliation(s)
- Stuart B Mazzone
- School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, Australia; and Department of Medicine, Johns Hopkins University Medical School, Asthma & Allergy Center, Baltimore, Maryland
| | - Bradley J Undem
- School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, Australia; and Department of Medicine, Johns Hopkins University Medical School, Asthma & Allergy Center, Baltimore, Maryland
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62
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Hulme K, Dogan S, Parker SM, Deary V. 'Chronic cough, cause unknown': A qualitative study of patient perspectives of chronic refractory cough. J Health Psychol 2017; 24:707-716. [PMID: 28810370 DOI: 10.1177/1359105316684204] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic refractory cough patients have persistent, unexplained, treatment-resistant symptoms. Very little is known about non-physiological processes underlying chronic refractory cough or patients' experience of the condition. In all, 14 patients participated in semi-structured interviews. Interviews were based on the comprehensive cognitive behavioural model and analysed thematically. Eight key themes emerged illustrating that the experience of the onset and persistence of chronic refractory cough is complex, often involving multiple interlinking factors. Themes highlighted the involvement of biological and psychological factors, and the prominent role of the social dimension in how the cough is experienced, perceived and managed. Implications for intervention development are discussed.
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Affiliation(s)
- Katrin Hulme
- 1 North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, UK.,2 Staffordshire University, UK
| | - Sian Dogan
- 1 North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, UK
| | - Sean M Parker
- 1 North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, UK
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63
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Song WJ, Morice AH. Cough Hypersensitivity Syndrome: A Few More Steps Forward. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:394-402. [PMID: 28677352 PMCID: PMC5500693 DOI: 10.4168/aair.2017.9.5.394] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 01/17/2023]
Abstract
Cough reflex is a vital protective mechanism against aspiration, but when dysregulated, it can become hypersensitive. In fact, chronic cough is a significant medical problem with a high degree of morbidity. Recently, a unifying paradigm of cough hypersensitivity syndrome has been proposed. It represents a clinical entity in which chronic cough is a major presenting problem, regardless of the underlying condition. Although it remains a theoretical construct, emerging evidence suggests that aberrant neurophysiology is the common etiology of this syndrome. Recent success in randomized clinical trials using a P2X3 receptor antagonist is the first major advance in the therapeutics of cough in the past 30 years; it at last provides a strategy for treating intractable cough as well as an invaluable tool for dissecting the mechanism underpinning cough hypersensitivity. Additionally, several cough measurement tools have been validated for use and will help assess the clinical relevance of cough in various underlying conditions. Along with this paradigm shift, our understanding of cough mechanisms has improved during the past decades, allowing us to continue to take more steps forward in the future.
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Affiliation(s)
- Woo Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Alyn H Morice
- Centre for Cardiovascular and Metabolic Research, University of Hull, Hull York Medical School, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom.
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64
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Abstract
Chronic cough is a common and troublesome condition affecting approximately 12% of the general population. It is associated with poor quality of life with psychological, social and physical consequences. Patients typically complain of a dry irritating cough, driven by a strong urge to cough associated with a sensation or irritation located in the throat. Treatment of potential 'causes', ie asthma, gastro-oesophageal reflux disease and rhino-sinusitis, may produce a complete or partial response, but the response of some patients to opiates and alpha-2-delta ligand antagonists (gabapentin and pregabalin) supports the concept that this is primarily a neurological disorder, characterised by hyper-responsiveness of the nerves. Novel and highly effective neuronal treatments are in development and offer hope of better symptom control with fewer side effects within a few years. This review focuses on understanding the mechanism of chronic cough, current management approaches and research that may lead to novel therapies.
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Affiliation(s)
- Imran Satia
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, and Manchester Academic Health Sciences Centre. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Huda Badri
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, and Manchester Academic Health Sciences Centre. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Bashar Al-Sheklly
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, and Manchester Academic Health Sciences Centre. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, and Manchester Academic Health Sciences Centre. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Ashley A Woodcock
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, and Manchester Academic Health Sciences Centre. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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65
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Affiliation(s)
- Jaclyn A Smith
- Division of Infection Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK.,University Hospital of South Manchester, Manchester, UK
| | - Jemma Haines
- University Hospital of South Manchester, Manchester, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
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66
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Affiliation(s)
- Jaclyn A Smith
- From the University of Manchester, University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Ashley Woodcock
- From the University of Manchester, University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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67
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Kang SY, Kim GW, Song WJ, Chang YS, Cho SH. Chronic cough in Korean adults: a literature review on common comorbidity. Asia Pac Allergy 2016; 6:198-206. [PMID: 27803879 PMCID: PMC5088255 DOI: 10.5415/apallergy.2016.6.4.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 01/15/2023] Open
Abstract
Chronic cough is a significant medical condition with high prevalence and a strong negative impact on the quality of life. Cough hypersensitivity is thought to underlie chronic cough, with several environmental and host factors interacting to cause neuronal sensitization and chronicity. Comorbid conditions affecting cough reflex pathways, such as upper airway diseases, asthma, and gastroesophageal reflux, play important roles in chronic cough. However, their prevalence may vary in patients living in different geographical regions or with different ethnicities. We conducted a literature review to examine common comorbidities in Korean adult patients with chronic cough, their clinical implications, and the issues that still need to be addressed in the development of clinical evidence of chronic cough in Korean adult patients.
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Affiliation(s)
- Sung-Yoon Kang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Gun-Woo Kim
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju 61661, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sang-Heon Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
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68
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Abstract
Chronic cough is common and has a significant impact on the wellbeing of patients and the use and cost of health care services. Traditionally the approach to chronic cough in patients who are nonsmokers and are not taking an angiotensin-converting enzyme inhibitor has focused on the diagnosis and management of the upper airway cough syndrome, asthma, and reflux disease. The evaluation of patients with chronic cough frequently involves trials of empiric therapy for these 3 conditions. Chronic cough may be perpetuated by abnormalities of the cough reflex and sensitization of its afferent and central components.
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Affiliation(s)
- Andreas Achilleos
- Internal Medicine Residency Program, Internal Medicine, Hershey Medical Center, 35 Hope Drive, Suite 104, Hershey, PA 17033, USA.
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69
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Ando A, Smallwood D, McMahon M, Irving L, Mazzone SB, Farrell MJ. Neural correlates of cough hypersensitivity in humans: evidence for central sensitisation and dysfunctional inhibitory control. Thorax 2016; 71:323-9. [DOI: 10.1136/thoraxjnl-2015-207425] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/07/2016] [Indexed: 12/17/2022]
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70
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Hennel M, Brozmanova M, Kollarik M. Cough reflex sensitization from esophagus and nose. Pulm Pharmacol Ther 2015; 35:117-21. [PMID: 26498387 DOI: 10.1016/j.pupt.2015.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 01/07/2023]
Abstract
The diseases of the esophagus and nose are among the major factors contributing to chronic cough although their role in different patient populations is debated. Studies in animal models and in humans show that afferent C-fiber activators applied on esophageal or nasal mucosa do not initiate cough, but enhance cough induced by inhaled irritants. These results are consistent with the hypothesis that activation of esophageal and nasal C-fibers contribute to cough reflex hypersensitivity observed in chronic cough patients with gastroesophageal reflux disease (GERD) and chronic rhinitis, respectively. The afferent nerves mediating cough sensitization from the esophagus are probably the neural crest-derived vagal jugular C-fibers. In addition to their responsiveness to high concentration of acid typical for gastroesophageal reflux (pH < 5), esophageal C-fibers also express receptors for activation by weakly acidic reflux such as receptors highly sensitive to acid and receptors for bile acids. The nature of sensory pathways from the nose and their activators relevant for cough sensitization are less understood. Increased cough reflex sensitivity was also reported in many patients with GERD or rhinitis who do not complain of cough indicating that additional endogenous or exogenous factors may be required to develop chronic coughing in these diseases.
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Affiliation(s)
- Michal Hennel
- Department of Pathophysiology and Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Mariana Brozmanova
- Department of Pathophysiology and Biomedical Center Martin, Comenius University in Bratislava, Jessenius Faculty of Medicine, Martin, Slovakia
| | - Marian Kollarik
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, USA.
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Multiple neural circuits mediating airway sensations: Recent advances in the neurobiology of the urge-to-cough. Respir Physiol Neurobiol 2015; 226:115-20. [PMID: 26455780 DOI: 10.1016/j.resp.2015.09.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 12/31/2022]
Abstract
The respiratory system is densely innervated by sensory neurons arising from the jugular (superior) and nodose (inferior) vagal ganglia. However, a distinction exists between jugular and nodose neurons as these ganglia developmentally originate from the neural crest and the epibranchial placodes, respectively. This different embryological origin underpins an important source of heterogeneity in vagal afferent biology, and may extend to include fundamentally different central neural circuits that are in receipt of jugular versus nodose afferent inputs. Indeed, recent studies using viral tract tracing and human brain imaging support the notion that airway sensors contribute inputs to multiple central circuits. Understanding the neural pathways arising from the airways and lungs may provide novel insights into aberrant sensations, such as the urge-to-cough, characteristic of respiratory disease.
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Chung KF, Canning B, McGarvey L. Eight International London Cough Symposium 2014: Cough hypersensitivity syndrome as the basis for chronic cough. Pulm Pharmacol Ther 2015; 35:76-80. [PMID: 26341666 DOI: 10.1016/j.pupt.2015.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 02/01/2023]
Abstract
At the Eighth International London Cough Conference held in London in July 2014, the focus was on the relatively novel concept of cough hypersensitivity syndrome (CHS) as forming the basis of chronic cough. This concept has been formulated following understanding of the neuronal pathways for cough and a realisation that not all chronic cough is usually associated with a cause. The CHS is defined by troublesome coughing triggered by low level of thermal, mechanical or chemical exposure. It also encompasses other symptoms or sensations such as laryngeal hypersensitivity, nasal hypersensitivity and possibly also symptoms related to gastrooesopahgeal reflux. The pathophysiologic basis of the CHS is now being increasingly linked to an enhancement of the afferent pathways of the cough reflex both at the peripheral and central levels. Mechanisms involved include the interactions of inflammatory mechanisms with cough sensors in the upper airways and with neuronal pathways of cough, associated with a central component. Tools for assessing CHS in the clinic need to be developed. New drugs may be developed to control CHS. A roadmap is suggested from the inception of the CHS concept towards the development of newer antitussives at the Symposium.
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Affiliation(s)
- Kian Fan Chung
- Experimental Studies, National Heart and Lung Institute, Imperial College London, UK; Royal Brompton NIHR Biomedical Research Unit, London, UK.
| | - Brendan Canning
- The Johns Hopkins Asthma and Allergy Center, Baltimore, MD 21224, USA
| | - Lorcan McGarvey
- Department of Respiratory Medicine, Centre for Infection and Immunity, Queen's University Belfast, UK
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